Name
PNEUMONIA, MYCOPLASMA
DESCRIPTION
DETAIL
CAUSES Mycoplasma pneumoniae infection -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Viral pneumonia β’ Bacterial pneumonia (including plague and tularemia in severe cases) β’ Fungal pneumonias β’ Pneumocystis carinii pneumonia β’ Chlamydia pneumonia, TWAR or psittaci β’ Legionella pneumonia β’ TuberculosisLABORATORY β’ Positive cold agglutinins (titer of 1:1024 or greater; or rising fourfold) in 50% of infections β’ M. pneumoniae culture (requires 7-10 days) β’ Complement fixation serologic assay shows fourfold rise in titer at 2-4 weeks after symptom onset β’ IgM antibody to M. pneumoniae in 80% of patients after 1-2 weeks of illness (enzyme immunoassay) β’ Detection of M. pneumoniae DNA by PCR testing of nasopharyngeal aspirate IMAGING Chest x-ray - diffuse interstitial infi ltrates; small bilateral pleural effusion present in 25% of cases
TYPENOTES
RISK FACTORS: Close community living (e.g., hospitals, prisons, military bases, fraternity houses). Some of largest outbreaks have been in army recruits, Family exposure, Immunocompromised patientsAPPROPRIATE HEALTH CARE Outpatient usually; inpatient if symptoms severe GENERAL MEASURES N/A ACTIVITY Rest during acute phase DIET Drink plenty of fluids DRUG(S) OF CHOICE β’ Erythromycin - children 30-50 mg/kg/day for 10-14 days; adults 500 mg every 6 hours for 10-14 days β’ Clarithromycin - children 15 mg/kg/d for 10-14 days; adults 250 mg bid for 10-14 days or Azithromycin - children 10 mg/kg po first day, 5 mg/kg po for days 2-5; adults 500 mg fi rst day, then 250 mg every day for 4 days. β’ Consider 3 weeks of therapy if patient has persistent cough or airway reactivity β’ Penicillins are ineffective against M. pneumoniae ALTERNATIVE DRUGS β’ Doxycycline 100 mg PO bid if older than 9 years β’ Levofl oxacin 500 mg PO qDay if older than 18 years β’ Adjunctive drugs - albuterol inhaler, 2 puffs qid for wheezing PATIENT MONITORING β’ Phone or in person followup β’ Clearing of chest x-ray should be documented if the patient is older than 50. In smokers, document a clear x-ray in 6-8 weeks. PREVENTION/AVOIDANCE Highly contagious, M pneumoniae is carried in respiratory droplets. Consider isolation of active cases in closed communities (schools, camps, military bases). Azithromycin prophylaxis (standard 5 day course) may lower attack rate. POSSIBLE COMPLICATIONS Note: All complications are rare except reactive airway disease, hemolytic anemia, and erythema multiforme. β’ Reactive airway disease β’ Hemolytic anemia β’ Erythema multiforme β’ Meningoencephalitis β’ Polyneuritis β’ Polyarthritis β’ Stevens-Johnson syndrome β’ Pericarditis β’ Myocarditis β’ Respiratory distress syndrome β’ Cerebral ataxia β’ Thromboembolic phenomena β’ Pleural effusion β’ Nephritis EXPECTED COURSE/PROGNOSIS β’ Mycoplasma infection symptoms usually resolve in about 2 weeks β’ Some constitutional symptoms may persist for several weeks β’ With correct therapy, even most severe cases can expect complete recovery
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
SERUM IGM, X-RAY CHEST P.A. VIEW( NORMAL ), COMPLETE BLOOD COUNT, PCR, SPUTUM FOR GRAM STAINING, SPUTUM FOR CULTURE & SENSTIVITY TEST